# PALM COAST EYE CENTER, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427098730
- **Authorized official:** LISA RENEE NICHOLS (PRACTICE MANAGER)
- **Authorized official phone:** (941) 794-2020

## Contact information

- **Practice address:** 5601 21ST AVE W, SUITE A, BRADENTON, FL 34209-5642
- **Practice address phone:** (941) 794-2020
- **Practice address fax:** (941) 792-3464
- **Mailing address:** 5601 21ST AVE W, SUITE A, BRADENTON, FL 34209-5642
- **Mailing address phone:** (941) 794-2020
- **Mailing address fax:** (941) 792-3464

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | OPC3917 | FL | — |
| 207W00000X | Ophthalmology Physician | ME0045451 | FL | Yes |

## Other

- **Enumeration date:** 06/07/2006
- **Last updated:** 04/10/2008